House of God Rule #15: Part 4 – Learning to Say “No”

This is a personal story about how we learned to say “no”. Sometimes, as doctors, we are so eager to please our peers and colleagues that before long we find ourselves committed to too many things – and our passion wanes. Learning to say “no” is an essential part of achieving that illusive work-life balance and allows you to direct your energies to the aspects of the job you truly love. We’ve done this the right way, the wrong way, and learned the hard way about not saying “no” when we should have.

Chris’ Story

About six weeks before Bridget and I sat our respective Physician Clinical Exams (a memorably hideous time characterized by stress, study and shift-work), Bridget woke up one morning covered in a non-blanching petechial rash. She was febrile with flu-like symptoms and was, at the time, working as an Infectious Diseases Registrar. Within two hours she had been admitted to her own hospital ward and was receiving treatment for what was later confirmed to be meningococcal bacteraemia.

I had called in sick and taken her to hospital and sat with her until she was up on the ward and medically stable a few hours later, intending to spend the day and possibly night with her. Just after lunch a consultant at my hospital called me and asked if there was any chance I could come in for a “few hours” that afternoon to help them get through the team’s ward work. To my very real, still raw and everlasting regret, after a moment’s hesitation and some reassurance from Bridget, I said “yes”.

“No” Three Ways

Learning to say “no” requires a special disposition; this is not about absconding from responsibility, but about being honest. Delivery of a good “no” requires you to be three things: certain, transparent, and quick.

Be Certain

There are occasions, and Chris looks back on that story as one of them, when the only right answer is “no”, no matter who it inconveniences or what price you pay professionally. “Ward work” was not an adequate reason to leave the bedside of a hospitalised spouse. The professional cost of saying “no” at that time would have been negligible or less – someone would have stayed back a bit that day and Chris could easily have helped them out another time. The trick is knowing when to say “no”. If in doubt, think carefully about what you’d advise a patient to do in the same circumstances, and then follow your own advice.

Be Transparent

The second lesson is that being transparent can help people understand why you’re saying no. This can make it easier to say no, because it can reduce the cost to you by keeping people on your side, even if you inconvenience them.

It can be as simple as “I’ve already made plans that day”, or contextual: “I’ve already committed to an audit for another department, I’m doing a course next month and I don’t think I’ll have the time to do your project justice”. If you would have loved to take the opportunity but can’t – say so, and say why! There will probably be more opportunities, and if people know when you will be available next they can keep you in mind.

Keep your reasons relevant and relatable to the person you’re talking to. In the example above, you might have nearly finished the audit and the course you’re doing is on photography, but these details don’t make it easier for the Professor to hear that you’re not doing their Grand Rounds. An audit. A course. You’re fully committed. That’s all they need to know.

Be Quick

Sometimes the best way to say “no” is quickly. We have both been offered wonderful opportunities to work with amazing people that we would have been crazy not to take, but under circumstances where it was obvious from the first conversation that we could not do it. The reasons have been geographic (can’t split the family), time (not wanting to work fulltime right now) and nearly (but-not-quite) impossible commute.

We’ve also been offered stomach-churning opportunities that we’ve felt obliged to say yes to, but which we did not want under any circumstances (thankless, difficult, time-consuming, stressful and/or boring).

Over time we have discovered that a very warm “thank you” followed by a very quick “no” is relatively painless in the short-term, and wonderfully liberating in the long-term. Best of all it gives the person who has asked you immediate clarity about your availability. They have not invested much time in considering you in that role and are therefore minimally inconvenienced by the fact you’ve declined it. The alternative is that you prevaricate, ask for time to think about it and string them along – and that’s when your “no” can become impossibly expensive.

The Cost of Saying “No”

Every now and then, saying “no” might not be received as you anticipated. Having a clear idea of your goals and priorities will help your conscience decide if the cost of “no” is worth it. Remember, this is about minimising disappointment. The cost of an upfront “no” now is far less damaging to your reputation than doing a half-hearted job later.

Putting It Into Practice

Saying “no” is difficult. It’s also necessary. Sometimes it’s imperative. If you’re certain, transparent and quick, saying “no” is often less costly, and much better, than you anticipate. If you’ve been realistic, made good choices and have a plan (or even if you haven’t), don’t be afraid to say “no”.

About The Author

Chris is a Consultant Paediatrician who works in a teaching hospital in Sydney and in private rooms. As well as clinical Medicine he is enthusiastic about health communication and teaching. Chris is a Conjoint Lecturer for the University of New South Wales and writes the occasional article on child health for mainstream media. He also teaches Advanced Paediatric Life Support and sits on the Editorial Board of the Journal of Paediatrics and Child Health. Chris completed his Internship at Bankstown Hospital and Paediatric training through the Sydney Children's Hospitals Network. On the days when he is not at work he enjoys playing with his children, and also when they play by themselves.